HomeMy WebLinkAboutPermit RenewalFrom: Mike Helssenberg Fax: 17728710990 To: Fax: (772) 462.2578 Page: 4 of 4 0612912020 22:34 AM -
PLANNING AND DEVELOPMENT SERVICES DEPARTMENT
• BUILD. ING AND: CODE REGULATIONS DIVISION -.
2300 VIRGINIA AVE
FORT PIERCE, FL 34982
{772) t62 1553 Fax (772) 462-t578
.. JJN 2 9 JJ20.
PERMIT RENEWAL.REQU
ES sT .
p Lucie County, permitting
HERMI(T}NUMBER: I�U ADDRESS: UQW
I' �� am requesting that the above permit be renewed. I
understand that I must schedule and all required inspections for the permit. to be finaled: Further, I
_ understand that this is a ONE TIME RENEWAL and the permit shall expire shouId. I not recgive a,
passing inspection during any six month period during.the renewal perio ..
Justification Q�Y'1 Oi WWIt,�
•
r !c
I ZU�
01VNER/B.LDR OR CONTRACTOR SIG _ -A. ATE
/%dlflic�%t�lSlv'fs(�IL9�BG�`'�"'1�
.STATE OF FLORIDA
:COUNTY OF
CST • ��S�CI� � ., .. '��...... ..... h ., ,��� .
.ACKNOWLEDGED BEFORE ME THIS 2/0�'7/
BY WHO IS PER$ONALLYKNOWN TO. ME J�/ , OR.
HAS PROVIDED
ASIDENTIFICATION,,
$.TATE.OFFLORIDA, Countyof_.
Taylor O'®P100 .
stGN+TtIRErJFNOTARy ... NOTARY PUBLIg
CWVW(G�
STATE OF FLORiIpA "
FOR OFFICE USE ONLY: ' ` ��.�...�_�_--^`"'
..
Number of Open Inspections:
Total Inspections: ..
{Divide open by TO to get of open inns
Percentage: peotion@) ...
Original permit fee: x %.open = $
Renewal fee
.:..............
E?k'unpie: 115d..iyided by23=.,6$C�O)I $175(pern it fec) x.65=$113.75: (renewal fee) ... ..... .
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